J Med Ethics: first published as 10.1136/jme.20.4.207 on 1 December 1994. Downloaded from J7ournal of medical ethics 1994; 20: 207-211

Ethics in scientific communication: study of a problem case

Robert L Berger Harvard Medical School, USA

Abstract should verify the integrity of the material prior to The hypothermia experiments performed on humans engaging in a dialogue. during the Second World War at the German concentration camp in Dachau have been regarded as Towards the end of the Second World War the allied crimes against humanity, disguised as medical research. armies came across an extensive network of barbaric For almost 50 years, scientists maintained that the medical experiments that had been conducted on study produced valuable, even if not totally reliable, humans by German physician investigators. One of information. In recent years, the results from the these projects dealt with immersion hypothermia Dachau hypothermia preject were glamorized with and was carried out at the Dachau concentration life-saving potential and a heated ethical dialogue was camp. The work was directed by Dr Sigmund activated about the use oflife-saving but tainted Rascher, an air force (Luftwaffe) medical officer.

scientific information. In the wake ofthe debate, an According to available information approximately copyright. in-depth examination of the scientific rigour ofthe 300 male prisoners were forced into iced water baths project was performed and revealed that neither the during 400 experiments so that many of the men science nor the scientists from Dachau could be trusted were cooled more than once (1). Postwar testimony and that the data were worthless. The body of medical indicates that 80 to 90 victims died during the opinion accepted the unfavourable determination but a freezing and attempted re-warming. Only a handful few scientists and ethicists have continued to endorse the of those who survived the experiments lived to see validity, of at least parts, of the Dachau hypothermia the end of the war. data. http://jme.bmj.com/ The conduct of the scientific communications about the Dachau hypothermia experiments by the scientific Reception and reporting of the Dachau and ethical communities invites serious consideration of hypothermia experiments a possible ethical misadventure. It appears thatfor After conclusion of the hostilities, a US army almost 50years, the results of the study had been neuropsychiatrist, Leo Alexander, was assigned to endorsed without careful examination of the scientific investigate the medical experiments performed on

base ofthe experiments and that secondary citation of prisoners at the Dachau concentration camp. The on September 25, 2021 by guest. Protected relevant original material may have been commonly records of most concentration camp medical studies employed. These infractions contributed to a myth that on humans were destroyed by the Germans prior to good science was practised by the Nazis at Dachau. The capture of the camps by the allied forces. However, a more recent emphasis on the life-saving potential of the 56-page scientific report about the Dachau human Dachau data, without citation ofcredible supporting hypothermia experiments, submitted by Rascher to evidence, has also been misleading. Similarly, Heinrich Himmler (commander of the SS and in acceptance of a determination by an in-depth charge of the concentration camps), was found by a examination that the 'whole' Dachau project is flawed US army unit, hidden in a salt mine near Hallein, with simultaneous endorsement of the validity of 'parts' Austria along with Himmler's massive files. In 1946, of the results, poses an ethical problem. Alexander submitted a 228-page report on the It is advisable that before seeking ethical results of his extensive investigation. The document consultation about the use of unethically obtained incorporated the complete Rascher to Himmler data, scientists should examine the quality of science report and has since served as essentially the sole behind the controversial information and ethicists original source material about the Dachau hypothermia experiments (2). Alexander concluded in his report, that even Key words though the experiments 'wallowed in blood', the Ethics in scientific communication; Dachau hypothermia work produced useful information (2). However, in experiments. a 1949 article, Alexander changed his earlier J Med Ethics: first published as 10.1136/jme.20.4.207 on 1 December 1994. Downloaded from 208 Ethics in scientific communication: study ofa problem case assessment and revealed that some of the data from art. Thus, in spite of cogent reasons for scepticism Dachau had proved fraudulent and the results of the about the quality or value of the Nazi hypothermia study could not be trusted (3). Similarly, at the data, the reliability of the work that produced the Nuremberg trials of major medical war criminals, information was not examined. both the prosecution and Dr Andrew Ivy, a Some scientists defended the use of the Dachau representative of the American Medical Association, data on the grounds that similar information would maintained that the concentration camp human not be available from other sources, as the inhumane experiments were of no medical value (4). experimentation performed in the concentration Moreover, scattered comments appeared in the camps had been unprecedented and in all likelihood medical literature about the unreliability of the would not be repeated (7,10). These investigators Dachau data (5). acknowledged that the science produced in Dachau Despite the scepticism expressed about the was flawed and that the chief investigator's integrity of the Dachau results, scientists in Canada, credibility was severely compromised but they also the United States and Great Britain have referred to insisted that selected results should be regarded as the study repeatedly. Moe noted that by 1984 more valid because they were consistent with observations than 45 scientific articles had cited the Dachau published by other reputable scientists (5,7,11). It hypothermia experiments (5). Frequent citation of was further argued that no conclusive evidence had the data from Dachau in reputable medical journals been presented to show that the data were defective eventually helped create an impression that, in spite and therefore there was no reason to reject the of the deplorable inhumane methods, the work was information. A detailed endorsement of the scientific scientifically correct. In the late 1 980s, Robert health of the Dachau hypothermia experiments was Pozos, a hypothermia physiologist, turned to the issued by Robert Pozos in 1989, through a recorded media and to the ethical community with his formal lecture (7). concern about using tainted data from Dachau. He acknowledged that the methods of the Dachau experiments were unethical but also expressed Re-evaluation and the response confidence in the scientific integrity of the study and Because of lingering doubts about the scientificcopyright. maintained that the use of the results could advance validity of the Dachau data and my scepticism about hypothermia research and improve on available the probability that such relatively obsolete treatment of hypothermia victims, with the potential information could be useful, I embarked on a of saving lives (6,7). thorough examination of the scientific quality of the A public debate ensued. Both the ethicists and the Dachau hypothermia experiments. In this effort, I media embraced the debate and dramatized the studied the Alexander report, reviewed his collected

issue as a moral dilemma about saving lives by using papers and the scientific literature about http://jme.bmj.com/ data obtained through unethical experiments. The hypothermia, relied on the knowledge gained from controversy was heated and intense (7,8,9). Along my experience with cooling several thousand with the promise of advancing science, the life- patients for heart surgery, and examined available saving potential of the data was heavily emphasized documents about medical experiments in Nazi but never in my view convincingly documented concentration camps (12). To my surprise, access to (8,9). Two critical premises about the data produced the Alexander report proved most difficult. The by the Nazis in Dachau were apparently taken for volume was not available in any of Boston's several granted and rarely discussed by the participants in medical libraries and only two copies circulated on September 25, 2021 by guest. Protected the recent dialogue. First, it was assumed that the through the nationwide interlibrary loan system. results from the hypothermia experiments were Parts of Alexander's report were also published in scientifically sound and secondly, the claim was the more readily available volumes entitled Trials of accepted that the data had the potential of advancing War Criminals before the Nuremberg Military Tribunals medical science and of saving lives. In spite of the but this source offers only an incomplete gross ethical violations and the doubts expressed reproduction and has rarely been cited in the about the scientific integrity of the study, the medical literature (1). The difficult access to the reliability of the data had not been investigated Alexander report combined with the undeserved (8,9). Moreover, the probability that the data from favourable reception of the Dachau hypothermia Dachau had become obsolete with the passage of data, raised the suspicion that not all who cited almost a half of a century, had not been entertained. Alexander's work had read the original text but had The major advances in knowledge about obtained the information from descriptions of the hypothermia during the last 50 years, accomplished document by others and then resorted to secondary through highly sophisticated technology, should citation by listing the original Alexander title as the have raised serious questions about the likelihood reference instead of the actual source they perused. that work performed with the relatively primitive The in-depth examination of the available methods of the early nineteen-forties could information revealed that the Dachau experiments contribute appreciably to the prevailing state of the were conducted without an organized experimental Robert L Berger 209 J Med Ethics: first published as 10.1136/jme.20.4.207 on 1 December 1994. Downloaded from

protocol, the methods of study were flawed and newspaper interview that 'after reading Berger's execution of the work was haphazard. Some of the report' he regarded the scientific methods of alleged observations were either falsified or fabricated the Dachau study as 'atrocious' (16). However, and the reported results showed internal incon- subsequently, a few scientists and seemingly a sistencies. Conclusions were frequently not justified greater number of ethicists have continued to place by the data presented. The project's chief investi- limited reliance on the scientific base of the Dachau gator, Sigmund Rascher, was not a qualified scientist hypothermia project and have claimed that the and lacked the integrity to conduct an acceptable results were in part sound and useful. In a recent scientific inquiry. His shortcomings as an investigator publication, the bioethicist Jay Katz and the were recognized by his colleagues and superiors. In hypothermia physiologist Robert Pozos, acknow- order to lend credibility to the Dachau hypothermia ledged that the Dachau study 'as a whole' lacked enterprise, Himmler recruited two competent scientific validity but insisted that parts are valid scientists. However, the two men served essentially as because 'individual findings are reported (from part-time consultants and did not have the power or Dachau) that either confirmed prior experimental the will to control the administrative or scientific data or produced new data that scientists in the West aspects of the study. Both advisers abandoned the have considered valid ...'. Katz and Pozos listed five project after the first 50 experiments and did not items from the Dachau study they believed to be participate in the remaining 350 studies. Available valid. Each of the five items was referenced documents also revealed that Rascher's other separately to my article, where they are listed as investigative efforts were motivated by greed for samples of what I consider to be unreliable power and material gain, evidenced gross incom- information from Dachau together with detailed petence and produced a brand of pseudoscience that reasons for the unfavourable judgement (17). featured torture and murder. Eventually Rascher lost Another expression of continued partial support the trust of his Nazi mentors. He was arrested, for the results produced in Dachau came in the form charged with a variety of crimes, including scientific of a British Broadcasting Corporation television

fraud, and was executed, presumably on the orders of programme that explored the ethical dilemma of copyright. his Nazi protector, Heinrich Himmler. In brief, the using the Dachau data (18). The BBC film featured, examination of the available information revealed among others, a British navy hypothermia specialist that neither the science nor the scientist from Dachau who related that the scientific methods used in could be trusted and the data produced were not Dachau left a great deal to be desired and that reliable or usable. Berger's paper represented 'a good critical analysis'. He added, however, that the available information is limited and not sufficient to pass an unfavourable

Scores ofletters judgement. He listed specific data from Dachau that http://jme.bmj.com/ The results of my analysis of the Dachau he thought were valid and valuable, plainly regarding hypothermia experiments were published in the New the available information as sufficient to validate England J7ournal of Medicine after the customary selected data from the project. The narrator further stringent peer review process (12). The reviewers argued that the results obtained in Dachau were accepted the conclusion that the 'science' emanating instrumental in the conception of an ongoing project from Dachau was severely flawed. A companion on protection against 'post-rescue collapse' from editorial in the same issue of the journal noted that: immersion hypothermia. The current work by the on September 25, 2021 by guest. Protected 'This evidence is sufficient for Berger to show British navy, presumably based on specific convincingly that the hypothermia experiments, in information from Dachau, was illustrated through addition to being bestial, were poorly designed and telegenic footage showing a helicopter rescuing a sloppily conducted, and the results were con- mock hypothermia victim from the ocean. The tradictory and probably freely fabricated. In short, connection between the work from Dachau and the the hypothermia experiments were scientifically ongoing research by the British navy investigators worthless' ... (13). Scores of letters to the editors seemed to me to be tentative. addressed the ethical dilemma of using or publishing the Dachau data but none took issue with the determination that the science was unacceptable and Cursory coverage the data unusable (14). In a position paper, authored During the half-hour BBC programme, only cursory by 17 physicians, The New York State Medical coverage was given to the detailed documentation Society's Commission on Ethics agreed that the about the flaws in the scientific methods of the science produced by freezing innocent prisoners in Dachau study. Three prominent ethicists discussed the ice tanks of Dachau was not reliable (15). Robert the dilemma about the use of the tainted data and Pozos, the physiologist who brought the issue about conveyed a distinct impression that in their view the the use of the Dachau data to the attention of the scientific information from Dachau was valid and media and of the ethicists, with the message that the that its use could save lives. Two concentration science was reliable, was quoted as having said in a camp survivors and a rabbi, with an apparent J Med Ethics: first published as 10.1136/jme.20.4.207 on 1 December 1994. Downloaded from 210 Ethics in scientific communication: study ofa problem case conviction that the science from Dachau was sound, mandates, in my opinion, rejection of the whole also voiced opinions about using the data. The body project and does not allow exemption of individual of medical opinion that the Dachau results were items. Usually an entire investigative effort is worthless, was hardly mentioned and then lost in the condemned even if only one part is fraudulent. With enthusiastic discussion about the use of tainted data the Dachau experiments, the entire project is with the potential of saving lives. suspect. Another suggestion that agreement between selected items from the Dachau project and prior Comments experimental results reported by others confirms the For nearly 50 years, scientists in the western world reliability of the Nazi data is also untenable. The referred liberally to the Dachau hypothermia fallacy of this concept is readily illustrated by experiments, despite the widespread contempt for Alexander's discovery that Rascher fabricated data the cruelty employed in the conduct of the research freely about the time-frame of tolerance for and the repeated reservations expressed about the hypothermia in order to be consistent with previous scientific integrity of the project. Surprisingly, the observations on German Air Force crews downed in misgivings about the reliability of the results failed to the cold sea, and to keep his project relevant to the trigger either a full examination of the quality of the goals set by his Nazi superiors (3). Thus, Rascher's work or greater circumspection about citing the data on tolerance for immersion hypothermia are study. clearly fraudulent, but they are also consistent with The initial misconceptions about the value of the previous observations by others. This example Dachau study may have been fortified in recent years illustrates that resemblance of two pieces of by scientists who in the process of seeking ethical information does not necessarily mean that both can guidance did not, in my view, give sufficient weight be trusted. to the persistent doubts about the scientific integrity Guidelines on communication between ethicists of the work (6,7). Moreover, both scientists and and scientists about the scientific aspects of ethical ethicists ascribed to the Dachau data life-saving issues are imprecise, since firm rules have not been potential that permitted a dramatic formulation of enunciated. Ethicists tend to assume that scientificcopyright. the controversy in terms of a life-and-death issue, issues brought to their attention for ethical which added greatly to the appeal of the debate. consideration are based on sound science. Since this Although the nature of the potentially life-saving may not be always the case, it is most important that data was never to my mind adequately identified, the before requesting ethical opinion, scientists should dramatization intensified the pitch of the con- scrutinize the quality of science behind topics with troversy. The topic became even more popular as the dubious ethical origins, and transmit a frank media joined in the fray. The conclusion, from my assessment of their findings. Similarly, prior to http://jme.bmj.com/ in-depth examination, that the science practised in embarking on ethical deliberations about the use of Dachau was inferior, has been accepted by a broad tainted data, ethicists have an obligation to verify the mix of scientists, including peer reviewers, editors of scientific integrity of a research effort with a medical journal, physicians writing to these editors questionable ethics and ensure that the information and a state medical society commission on is usable. The mere initiation of an ethical dialogue biomedical ethics. It seemed logical that docu- can promote untrustworthy products and the very mentation of the scientific flaws in the Dachau conduct of the debate can bestow scientific experiments would dispel any misconception on the endorsement. A combined effort by ethicists and on September 25, 2021 by guest. Protected utility of the information and confirm the futility of scientists can identify unreliable information that the ethical debate concerning the use of the data. does not warrant ethical discussion about its use. The logic behind acceptance of selected parts of the The drama or the glamour of a topic should not data from Dachau deserves further comment. blind one into an inappropriate dialogue. The proposition by endorsers of the Dachau data that the study 'as a whole' cannot be trusted but selected items are valid and can be used, con- Holocaust revisionists travenes, in my view, fundamental standards of the Inferior science is usually rejected and not used by scientific process. The Dachau hypothermia scientists. Ethicists are rarely consulted about the experiments featured fraud and incompetence use of non-usable data even if they were obtained by performed by an investigator who was a habitual liar, unethical means. Jay Katz, a prominent biomedical so that no part of the project can be trusted even if ethicist, noted that '... it seems evident that the selected components happen to be in agreement ethical problem of using data and benefiting from with data produced by others. The flaws pervade the evil is moot, if they prove to be useless ...' (20). In whole work and do not permit separation of the view of the body of medical opinion that the Dachau results into credible and non-credible categories any hypothermia experiments did not produce usable more than the truth can be discerned from the scientific information, the continued reliance even utterings of a habitual liar (19). The evidence on parts of the data must be questioned. I am Robert L Berger 211 J Med Ethics: first published as 10.1136/jme.20.4.207 on 1 December 1994. Downloaded from compelled to challenge the view that the (2) Alexander L. The treatment of shock from prolonged pseudoscience practised in a Nazi concentration exposure to cold, especially in water. Combined camp was genuine science and to debunk a intelligence objectives subcommittee. Target no 24, misconception that the scientific quality of tainted report no 250. Washington, DC: Office of the data is irrelevant to ethical dialogues. The debate Publication Board, Department of Commerce, 1946. about the use of the Dachau hypothermia data has (3) Alexander L. Medical science under dictatorship. already created what I consider to be an erroneous New Englandjournal of medicine 1949; 241: 39-47. favourable impression about the scientific quality of (4) Mitscherlich A, Mielke F. Doctors of infamy: the story at least one flawed Nazi medical project, and has in of the Nazi medical crimes. [Norden H trans.] New my view helped to advance, perhaps unwittingly, the York: Henry Schuman, 1949. assertion by Holocaust revisionists that the medical (5) Moe K. Should the Nazi research data be cited? experiments perpetrated in German concentration Hastings Center report 1984; 14, 6: 5-7. camps were justified since the results advanced (6) The MacNeil/Lehrer News Hour [TV programme]. New York and Washington. Corporation for Public science and medicine and thus, Hitler's madness Broadcasting. 1988 Aug 1. benefited humanity. (7) Pozos R S. Can scientists use information derived Cessation of the debate about use of the data from from concentration camps? In: Conference on the Dachau, does not mean banning access to meaning of the Holocaust for bioethics. University information about the Dachau hypothermia of Minnesota, Minneapolis, 1989 May 17-19. experiments or relegating the truth about the evils of Transcription of official recording, 1989: 1-17. Nazi science to oblivion. Human experimentation in (8) The Holocaust and biomedical ethics. Conference on the the German concentration camps represents a meaning of the Holocaust for bioethics. University of chapter of shame in the history of medicine. Minnesota, Minneapolis, 1989 May 17-19. (9) Caplan A L, ed. When medicine went mad. Totowa, Civilization cannot afford a second coming of NJ: Humana Press, 1992. Dachau and the lessons from the experience cannot (10) Hegnauer A H. Lethal hypothermic temperatures for be ignored by blotting from memory the horrors of dog and man. Annals of the New York Academy of Nazi science. The story about perversion of medical Science 1959; 80: 315-319. experimentation by German scientists needs to be (11) Pozos R S. Scientific inquiry and ethics. See reference copyright. recalled and recorded in the annals of medical (9): 108. research as an episode of infamy that featured (12) Berger R L. Nazi science - the Dachau hypothermia torture, murder and almost complete genocide with experiments. New England journal of medicine 1990; the enthusiastic co-operation of individual Nazi 322: 1435-1440. doctors and the the (13) Angell M. The Nazi hypothermia experiments and support of German medical unethical research today. New England journal of establishment. Instead of expending our energies on medicine 1990; 322: 1462-1464. debating the ethical implications of the use of the (14) Nazi science [letters to the Editor - several]. New http://jme.bmj.com/ useless, we must dedicate our efforts to exploration Englandjournal of medicine 1991; 324: 845-847. of the genesis of these crimes perpetrated in the (15) Rosner F, Bennett A J, Cassell EJ et al. The ethics of name of medicine and persist in our determination using scientific data obtained by immoral means. New to prevent exploitation or violation of innocent York statejournal of medicine 1991; 91: 54-59. victims in the name of medical science. (16) Lutz D. Surgeon calls hypothermia research bad science. Minnesota daily 1990 May 17: 12. Robert L Berger, MD, is Associate Clinical Professor of (17) Katz J, Pozos R S. The Dachau hypothermia study -

an ethical and scientific commentary. See reference on September 25, 2021 by guest. Protected Surgery, Harvard Medical School, Boston, USA. (9): 135-140. (18) Nazi science [TV programme]. British Broadcasting Corporation. Antenna team. 1991. References (19) Berger R L. Nazi science. Comments on the (1) Freezing experiments. In: Trials ofwar criminals before validation of the Dachau hypothermia experiments. the Nuremberg Military Tribunals [vol 1]: The medical See reference (9): 109-134. case. Washington, DC: Government Printing Office, (20) Katz J. Abuse ofhuman beings for the sake of science. 1946-49: 198-260. See reference (9): 234-270.